What is TMS?
Transcranial Magnetic Stimulation (TMS) is a non-invasive neurostimulation therapy. It uses changing magnetic fields to stimulate the brain’s nerve cells. TMS has been shown to improve symptoms of various forms of pain, depression, and other psychiatric conditions, such as obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), even when more traditional treatments like antidepressant drugs have failed.
TMS treatment has been also used in a range of other medical conditions, including medical rehabilitation (i.e. post stroke), neurology and ENT (such as tinnitus). Different regions of the brain can be targeted by holding a specially designed coil near the patient’s scalp. The applied field of energy passes small electromagnetic currents to stimulate nerve cells in that particular brain region.
At Modalis, we utilise the process of Neural Navigation to ensure focus on and stimulation of the correct area of the brain.
A technology proven to help and heal
TMS therapy usually involves several repetitive sessions; this is referred to as repetitive Transcranial Magnetic Stimulation (rTMS). rTMS has been studied extensively since 1985 and represents the most active area of neurostimulation techniques in psychiatry, pain management and rehabilitation medicine. There is a wealth of medical research on the advances and efficacies of this form of treatment, that continues to grow.
How can TMS therapy help me?
TMS works via a myriad of complex pathways. One mechanism in particular, appears to involve opioids, which are the body’s natural pain-relieving chemicals. When rTMS stimulates the brain area involved in pain, there is a significant release of these natural opioids. They work in conjunction with several other brain chemical systems to create long-term changes to the brain cells involved in pain. This provides substantial pain relief beyond the time of stimulation.
For this treatment condition, an area of the brain called the primary motor cortex (M1) is typically targeted. A range of other, different regions of the brain could be stimulated to address other forms of pain, such as neuropathic pain, fibromyalgia, migraines and other. TMS Therapy can also be used for tinnitus (ringing in the ears).
Depression / Obsessive-compulsive disorders (OCD) / Post-traumatic stress disorder (PTSD)
rTMS has a established record of being an effective alternative to some groups of antidepressants. Research also suggests that targeting the stimulation more precisely within the area of the dorsolateral prefrontal cortex (DLPFC) can improve depressive symptoms. There are a number of methods of stimulating the DLPFC involving right and left hemispheres with low (1Hz) and high (10Hz) frequencies, depending on the pattern of symptoms and the specific clinical indications for rTMS.
TMS is being increasingly used for OCD, some symptoms of psychoses (esp. auditory hallucinations) and PTSD, amongst others. Psychiatric symptoms such as OCD require specific modification to the stimulation regions (Orbitofrontal cortex) and some modification to the rTMS coil (“deep coil”). To this end, Modalis follows well researched and published protocols.
Other Indications (Tinnitus and Neurology)
Tinnitus is a subjective perception of a sound, such as ringing or buzzing, without the presence of an external or internal source with a duration of at least three months. It is a very distressing and, frequently, very chronic condition with affects approximately 10–15% of people living in industrial countries.
From a neurophysiological perspective, subjective tinnitus is therefore associated with altered neural activity along the auditory pathway and hyperactivity in auditory brain areas as well as non-auditory brain areas. These given pathological neural circumstances represent a significant leverage point for the application of repetitive transcranial magnetic stimulation (rTMS).*
At Modalis, we offer rTMS as a part of broader clinical interventions for this condition. We are also collaborating with neurologists to establish protocols for utilising rTMS in a range of neurological conditions, either as a form of safely treating the affective coexisting/comorbid distress (this group of patients frequently does not tolerate antidepressant medication) and/or directly targeting the primary neurological problems, such as:
stroke rehabilitation •
motor disorders and others •
*Theodoroff et al 2013
Advantages of TMS Therapy
The safety profile of TMS Therapy is one of its major advantages. As a non-invasive neurostimulation technique, it requires no pharmacological intervention. Instead, it harnesses natural electromagnetic waves to target the outer part of the brain (cortex). Thus, TMS activates various regulatory processes and connections between brain regions. In some ways, it is similar to an MRI but uses much less intense magnetism. There are very few contraindications to TMS Therapy and it is generally very well tolerated, with only a small percentage of patients who choose to discontinue treatment.